AB1017 DETERMINANTS OF SLEEP DISORDERS IN AXIAL SPONDYLOARTHRITIS: A CONTROLLED STUDY
Authors: C. Valera-Ribera, E. Valls-Pascual, A. Mayo-Juanatey, E. Flores-Fernández, P. Andújar-Brazal, I. Vázquez-Gómez, A. Ybañez Garcia, À. Martínez-Ferrer, J. J. Alegre Sancho
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Axial spondyloarthritis (axSpA) is a chronic joint disease, characterized by inflammation and damage of the axial skeleton. It is frequent for patients to experience pain during periods of rest, such as during night sleep. A limited number of studies address the relationship between axSpA and sleep quality (SQ), although it represents a major concern for patients. Moreover, most of these studies lack a control group and do not explore the different areas of sleep. <h3>Objectives</h3> To describe the prevalence of sleep disorders in patients with axSpA and compare it with a healthy population. To analyse the determinant factors associated with SQ in both populations. To analyse the effect of structural damage, disease activity and its specific treatments on sleep quality. <h3>Methods</h3> We conducted a cross-sectional study. The cohort was composed of adult axSpA patients followed in the Rheumatology outpatient clinic at Doctor Peset University Hospital, and age- and gender-matched healthy individuals. Participants with known sleep diseases were excluded. The following variables were collected for both patients and controls: age, gender, perceived health, weekly physical activity, employment situation, and annual level of income, history of anxiety and/or depression and active treatment for it. The following variables were collected for axSpA patients: year of diagnose, BASFI, BASDAI and ASAS-HI scores, current dosage of glucocorticoids, use of NSAIDs and conventional, biologic or targeted synthetic DMARDs, and presence of syndesmophytes on plain radiography. The Pittsburgh Sleep Quality Index (PSQI) questionnaire, which evaluates sleep quality and disturbances over a month time interval, was applied. This questionnaire studies 7 different sleep domains: subjective quality, latency, duration, efficiency, disturbances, use of sleeping medication, and daytime dysfunction. A regression model was created to estimate the influence of the collected variables on the results of this questionnaire. <h3>Results</h3> 57 axSpA patients and 50 healthy controls were included. There were no statistical differences in mean age and sex percentage between both groups. According PSQI scores, 87.72% of patients and a 62% of controls were classified as "poor" sleepers. SQ was related to axSpA (p = 0.002), anxiety (p = 0.003), perceived health (p = 0.001) and physical activity levels (p = 0.006). The domains of subjective sleep quality, latency, duration, efficiency and sleep disturbances were negatively affected by axSpA (p &lt; 0.05). The estimated odds ratio of having a sleep disorder was 5.63 times higher in patients diagnosed with axSpA. With regards to AS patients; anxiety (p &lt; 0,001), physical activity (p = 0,015), BASDAI scores (p = 0,001), BASFI scores (p = 0,038) and axial syndesmophytes (p=0,028) were found to affect the PSQI score. <h3>Conclusion</h3> Patients with axSpA have a poorer sleep quality when compared to healthy individuals. AxSpA affects subjective sleep quality, latency, duration, efficiency and sleep disturbances. Disease activity and the presence of syndesmophytes have a detrimental effect, whereas physical activity has a positive effect on SQ. Therefore, these factors must be considered when attending this area of our patient's health. The PSQI questionnaire provides a complete approach to sleep health and should be considered a complementary tool for the management of axSpA patients. <h3>References</h3> [1]Li Z, Fu T, Wang Y, Dong C, Shao X, Li L, Gu Z. Sleep disturbances in ankylosing spondylitis: a systematic review and meta-analysis. Psychol Health Med. 2019 Sep;24(8):911-924. doi: 10.1080/13548506.2019.1574357. Epub 2019 Apr 23. PMID: 31012756. [2]Urkmez B, Keskin Y. Relationship between sleep quality and physical activity level in patients with ankylosing spondylitis. Mod Rheumatol. 2020 Nov;30(6):1053-1059. doi: 10.1080/14397595.2019.1702139. Epub 2020 Jan 14. PMID: 31810412. [3]Da Costa D, Zummer M, Fitzcharles MA. Determinants of sleep problems in patients with spondyloarthropathy. Musculoskeletal Care. 2009 Sep;7(3):143-61. doi: 10.1002/msc.155. PMID: 19422064. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.